Provider Demographics
NPI:1306391164
Name:NIX, ANNA JENNINGS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:JENNINGS
Last Name:NIX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:JENNINGS
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:539A HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4193
Mailing Address - Country:US
Mailing Address - Phone:601-924-4900
Mailing Address - Fax:601-924-4944
Practice Address - Street 1:539A HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4193
Practice Address - Country:US
Practice Address - Phone:601-924-4900
Practice Address - Fax:601-924-4944
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPEDO-549-181223P0221X
MS3862-161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry